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BACKGROUND: Technology in recent times has shown exciting advancements. These advancements have been implemented in healthcare settings to improve therapeutic outcomes. Within the domain of communication disorders, stuttering has witnessed the implementation of a wide variety of technological interventions. This paper provides a comprehensive review of the current status of technology-based stuttering intervention programs, their advantages and disadvantages, and a few directions for future research. AIM: This review aimed to systematically identify the technologies used in stuttering intervention and explore the effect of these interventions on dysfluencies in stuttering. METHOD: We followed the conventional systematic review process and searched six electronic databases using relevant keywords. We included intervention studies published since 1990 on individuals diagnosed with developmental stuttering. In addition, all studies that used technological intervention such as device(s), computer programs, and mobile phone applications were included. RESULT: Fifty-nine studies were included after a thorough eligibility check. The major categories of technological rehabilitation include telehealth technology, software programs, biofeedback, virtual reality, video-self modeling, neuromodulation, and altered auditory feedback. In general, the results show a beneficial effect of technological intervention in reducing stuttering. Further, this review identifies reduction of the duration and minimal to no side effects with such intervention technologies in stuttering. Finally, the percentage of stuttered syllables (%SS) emerged as the most common outcome measure in technology-based intervention in stuttering. CONCLUSION: A wide variety of technological applications have been implemented in stuttering intervention. Regardless of type, all the studies that aimed to examine the effect of the technological intervention on stuttering reported positive outcomes. This review highlights technology-based stuttering intervention programs’ current status and their impact on stuttering dysfluencies. Further, it highlights several advantages and disadvantages of implementing technology-based interventions, and a few directions for future research.

The kinematic raw data in this project has been analyzed using a software code that was tailor- generated by the team to deduce the final kinematic parameters of total movement time, average velocity and shoulder and elbow flexion and extension angles

A majority of stroke patients have persisting upper extremity impairments, with a large number of individuals who do not regain the ability to reach and manipulate everyday objects despite receivin...

To design and test the feasibility of context-specific activities for improving physical activity (PA) levels among Indian adults with stroke. Context-specific activities were developed after a tho...

Purpose: To estimate the levels of physical activity (PA) in community-dwelling adults with stroke and to correlate it with the quality of life (QoL). Methods: In a cross-sectional study, adults with chronic stroke were assessed for PA using Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) and an accelerometer (Actigraph GT3X).QoL was assessed using Stroke Specific Quality of Life (SSQoL).Results: PA levels of our participants (n¼33; mean age 58.4 ± 12.1 years; mean FMA score 165.7 ± 31.1) were low with the mean activity of 252.9 ± 149.2 kilo counts per day and median energy expenditure of 77(44.6, 117.7) kilocalories per day. Median step count was 1635 (1084.9, 2434.3) steps per day. Mean time spent in sedentary and light activities were 504.1 ± 139 and 149.8 ± 68.3minutes per day, respectively. Median time spent in moderate and vigorous activities were 1.6(1, 4.4) and 0(0,0) minutes per day, respectively. Median PASIPD score was 12.3(6.1, 25.8) MET. Hours/day. SSQoL was found to have a positive correlation with average kilo counts/day, kilo calories/day, steps/day and PASIPD (r¼0.48, p¼.06; r¼0.46, p¼.009; r¼0.44, p¼.016; and r¼0.61, p�.001 respectively). Conclusions: PA levels of adults with stroke living in the semi-urban region of India are low and do not meet the recommended guidelines

Objective To evaluate and summarize the level of evidence for the immediate, short-term, and long-term effects of game-based rehabilitation on upper limb function in adults within the first six months following stroke. Introduction A game-based intervention is a valuable therapeutic tool for incorporating principles of motor learning and neuroplasticity in the rehabilitation of upper limb function post-stroke. Most of the existing reviews on game-based rehabilitation are focused on the chronic phase of stroke. However, as maximum upper limb motor recovery occurs in the first six months after stroke, further exploration of the effects of game-based rehabilitation in this phase is necessary. Inclusion criteria We will include randomized clinical trials assessing the immediate, short-term, and long-term effects of game-based rehabilitation on upper limb function in adults within the first six months following stroke. Methods The systematic review will follow the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist and JBI methodology for systematic reviews of effectiveness. A database-specific search strategy will be used in CINAHL, PubMed, Scopus, Web of Science, ProQuest, PEDro, OT Seeker, and Ovid MEDLINE to identify studies in the English language with no date limit. Two reviewers will independently screen, extract data, and assess risk of bias of the eligible studies. Meta-analysis and publication bias evaluation will be done when adequate data are available. If a meta-analysis is precluded, then a narrative synthesis will be done. The Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria will be used to assess the certainty of evidence for the outcome measures of interest. Systematic review registration number PROSPERO CRD42020190100.

Stroke survivors often face difficulty in community ambulation though they attain steady-state walking in clinical setups. Compliance and unpredictability of the environment may alter the muscle activity and challenge the individual's gait. Successful reintegration into the community requires gait assessment and training in a real-life challenging environment. Little is known about the assessment and training of gait in the community environment under challenging mobility dimensions. Hence, we aimed to study the changes that real-life environmental dimensions have on the activity of selected muscles in hemiparetic lower limb and gait velocity in stroke survivors.An observational cross-sectional study was conducted on 16 ambulatory stroke survivors to assess the hemiparetic lower limb muscle activity during walking in real-life environmental dimensions. Participants were made to walk in the community on a walkway consisting of even surface, ramp, stairs, uneven terrain and obstacles. They were also made to manoeuvre through traffic and pick a load while walking for a distance in the walkway. Muscle activity of Rectus Femoris, Biceps Femoris, Gastrocnemius Medialis and Tibialis Anterior of the paretic lower limb were continuously recorded while walking using wireless surface electromyography. Gait velocity for the entire walkway and level of perceived difficulty while walking in different dimensions were also measured. Paired t-test was used to compare the percentage Maximum Voluntary Contraction (%MVC) of lower limb muscles between even surface and real-life environment dimensions while walking. One sample t-test was used to compare the gait velocity in real-life dimensions versus gait velocity in even surface measured in an earlier study.There was a significant reduction (p 0.01) in the activity of all four hemiparetic lower limb muscles while walking under the influence of real-life environmental dimensions compared to even surface. Gait velocity (0.33 ± 0.17 m/s) was significantly lower than that is essential to be a community ambulator. The level of perceived difficulty across all dimensions was reported qualitatively with the highest difficulty reported during stair and obstacle clearance.Real-life environmental dimensions lead to the reduction of paretic lower limb muscle activities and gait velocity during walking in community-dwelling stroke survivors. Stroke survivors perceived more difficulty while walking in real-life environment dimensions particularly while negotiating stairs and obstacles.Knowledge about the influence of real-life environmental dimensions will help the clinicians to target rehabilitation methods to improve walking adaptability.

Introduction Game-based rehabilitation is an emerging therapeutic intervention that allows intensive, repetitive, task-based training to improve upper limb (UL) function following stroke, based on the principles of neuro-plasticity and motor (re)learning. Rehabilitation using commercial gaming system will be motivating, enjoyable, challenging and affordable. Therefore, the present study aims at assessing the effectiveness of an intensive, functional, gamified rehabilitation program using the ArmAble™ device in improving UL motor function in people with stroke. Method In this single-blinded, multi-centric, randomized clinical trial, 120 adults with acute/sub-acute unilateral stroke will be randomized to receive an intensive, functional, gamified training program using the ArmAble™ or task-based training along with a conventional therapy for 2 h/day, 6 days/week for 2 weeks, followed by a home-based, functional rehabilitation program for another 4 weeks (~30 min/day, 6 days/week). Primary outcomes evaluated by a blinded assessor at the baseline, 2 weeks and 6 weeks' post-intervention will include the Fugl-Meyer assessment – upper extremity and the action research arm test. A linear mixed effect regression model or relevant non-parametric tests will be used to analyze the data for all outcomes. An intention-to-treat analysis will be used with missing data handled by multiple imputation. Discussion Rehabilitation provided with the ArmAble™ device, if found effective, can be used from the early stages post-stroke to provide intensive, repetitive, gamified training to improve UL motor function. Trial registration number: CTRI/2020/09/027651.

Objective: To assess the feasibility of using short-term balance training with computer-based visual feedback (BTVF) and its effect on standing balance in children with bilateral spastic cerebral palsy (BSCP).Methods: Out of the fourteen children with BSCP (mean age = 10.31 years), seven children received four sessions of BTVF (two such sessions/day, each session = 15 min) in comparison to the control group that received standard care. Feasibility was measured as percentages of recruitment, retention and safety and balance was measured using a posturography machine as sway velocity (m/s) and velocity moment (m/s2) during quiet standing. Results: No serious adverse events occurred in either group. There were no differences in the retention percentages and in any clinical outcome measure between both groups. Conclusion: Use of BTVF is feasible in children with BSCP but further investigation is required to estimate a dose–effect relationship.

Reason for withdrawal from publication Authors have made no progress with this protocol in 7 years. The Cochrane Review Group was unable to maintain contact with the contact author. The co-authors are unable to take over this protocol. The topic will be included in another protocol: Continuous exercise training, resistance exercise training and mixed training interventions for arterial hypertension in adults.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To investigate the evidence for the efficacy of physical fitness training in the rehabilitation of spinal cord injury when compared to no training or usual care.

We agree with Lake and colleagues on their list of key ingredients for building humanlike intelligence, including the idea that model-based reasoning is essential. However, we favor an approach that centers on one additional ingredient: autonomy. In particular, we aim toward agents that can both build and exploit their own internal models, with minimal human hand-engineering. We believe an approach centered on autonomous learning has the greatest chance of success as we scale toward real-world complexity, tackling domains for which ready-made formal models are not available. Here we survey several important examples of the progress that has been made toward building autonomous agents with humanlike abilities, and highlight some outstanding challenges.

A granular cell tumor of the breast parenchyma is a rare tumor accounting for 5-6% of all granular cell carcinoma and are mostly benign in nature. The malignant granular cell tumour is rare tumor that comprise 1-2% of all granular cell tumors. This is a case of a 35-year woman who presented with a palpable mass in the right breast. On wide local excision, a diagnosis of benign granular cell carcinoma was made. On follow up, with a disease free interval of one year, she developed local recurrence and she underwent simple mastectomy with adjuvant radiation therapy. Histopathological examination, confirmed benign granular carcinoma. This is one such case where histologically confirmed to be benign, but the clinical behaviour of the tumour favoured malignant variety. Hence adjuvant therapy should be considered for this benign appearing, malignant tumour. Granular cell tumour [GCT] or Granular Cell Schwannoma of the breast is a rare benign tumour of the neural cells. It is commonly noticed in the oral cavity and other soft tissues [1]. About 5-8% of GCTs occurs in breast [2]. Most of the GCT in the breast are benign in nature and occurrence of malignant GCT is even rarer. We encountered a GCT in the breast of a pre-menopausal women which morphologically did not show any conventional features of malignancy but it acted in an aggressive fashion. The aim of this case report was to increase awareness of the existence of a rare benign looking variant of GCT with clinical aggression.

Background: Under normal circumstances, change in heart rate variability (HRV) in pregnancy projecting alterations within the regulation of the autonomic nervous system (ANS). Many previous works have shown an impact of gestation on the role of ANS in control of heart rate in the western country; however, it is poorly understood in Indian population, but then again a definitive this study is beneficial in relating to the influence on maternal autonomic cardiovascular control in some aspects of physiology in normal pregnancy. Aims and Objective: The aim of our study was to analyze the cardiac autonomic control throughout different stage of pregnancy with HRV. Materials and Methods: This study (n = 200) comprised normal non-pregnant and pregnant participants in the age of 20–30 years old, were divided randomly into Group 0 (n = 50) - control group comprised non-pregnant, healthy women. Study group (n = 150) classified into three subgroups; Group 1 (n = 50) - participants in their first trimester, Group 2 (n = 50) - participants in their second trimester, and Group 3 (n = 50) - participants in their third trimester. The electrocardiographic R-wave-R-wave interval HRV was measured on a beat-to-beat basis with the help of an electrocardiogram machine (BPL Cardiart 1087/MK-V) for 5 min. Result: Mean RR interval was decreased significantly in the 3rd trimester of pregnant study group when compared to non-pregnant control groups. Root of the mean of the sum of the squares of differences, NN50, and pNN50 were increased significantly in the first trimester of the pregnant study group when compared with non-pregnant control groups. Low frequency (LF) and LF (nu) significantly decreased, high frequency (HF) and HF (nu) significantly increased in the 1st trimester and significantly altered in 2nd trimester as well as 3rd trimester as vice versa. LF/HF ratio was significantly decreased in the 1st trimester and significantly increased in the 2nd trimester as well as 3rd trimester of pregnant study group when compared to non-pregnant control groups. Conclusion: The cardiac autonomic nervous activity in pregnancy showed a higher parasympathetic dominance in the 1st trimeste r and decreased gradually in 2nd trimester as well as 3rd trimester, and there was a lower sympathetic activity in the 1st trimester and increased gradually in the 2nd trimester as well as 3rd trimester. These changes throughout normal pregnancy may have an advantage in the initial identification of abnormal physiological function.

An attempt has been made to interpret the outcomes of a Life Cycle Assessment (LCA) in terms of environmental costs. This attempt ensures the environmental accountability of the products while LCA ensures their eco-friendly nature. Keeping this as an objective, a Life Cycle Environmental Cost Analysis (LCECA) model was developed. This new tool incorporates costing into the LCA practice. This model prescribes a life cycle environmental cost model to estimate and correlate the effects of these costs in all the life cycle stages of the product. The newly developed categories of eco-costs are: costs of effluent treatment/control/disposal, environmental management systems, eco-taxes, rehabilitation, energy and savings of recycling and reuse strategies. The mathematical model of LCECA determines quantitative expressions between the total cost of products and the various eco-costs. The eco-costs of the alternatives are compared with the computational LCECA model. This method enables the environmental as well as the economic assessment of products, which leads to cost-effective, eco-friendly design of products.

A forest fire can be a real ecological disaster, regardless of whether it is caused by natural forces or human activity. It is impossible to control nature, but it is possible to map forest fire risk zones and thereby minimise the frequency of fire, avert damage, etc. Forest fire risk zones are locations where a fire is likely to start, and from where it can easily spread to other areas. Anticipation of factors influencing the occurrence of fire and understanding the dynamic behaviour of fire are critical aspects of fire management. A precise evaluation of forest fire problems and decisions on solution methods can only be satisfactorily made when a fire risk zone map is available. Satellite data plays a vital role in identifying and mapping forest fires and in recording the frequency at which different vegetation types/zones are affected. A geographic information system (GIS) can be used effectively to combine different forest-fire-causing factors for demarcating the forest fire risk zone map. Gorna Subwatershed, located in Madhya Pradesh, India, was selected for this study because it continually faces a forest fire problem. A colour composite image from the Indian Remote Sensing Satellite (IRS) 1D LISS III was used for vegetation mapping. Slope and other coverages (roads and settlements) were derived from topographic maps and field information. The thematic and topographic information was digitised and ARC/INFO GIS software was used for analysis. Forest fire risk zones were delineated by assigning subjective weights to the classes of all the layers according to their sensitivity to fire or their fire-inducing capability. Four categories of forest fire risk ranging from very high to low were derived automatically. Almost 30% of the study area was predicted to be under very high and high-risk zones. The evolved GIS-based forest fire risk model of the study area was found to be in strong agreement with actual fire-affected sites.